BREAST-CANCER IN ELDERLY WOMEN - A RETROSPECTIVE ANALYSIS OF COMBINEDTREATMENT WITH TAMOXIFEN AND ONCE-WEEKLY IRRADIATION

Purpose: To evaluate retrospectively the efficacy of combined modality treatment (hormone therapy and hypofractionated radiotherapy) in a po pulation of very elderly women with breast cancer. Methods and Materia ls: Records on 70 patients of median age 81 years, treated between Jan uary 1988 and Febuary 1994, whose median follow-up is now 36 months, h ave been evaluated. Information obtained included clinical stage at di agnosis, histology, tumor grading, hormone receptor levels, details of treatment, type of failure, survival data, and status at last follow- up examination. Treatment consisted of Tamoxifen 20 mg daily and a hyp ofractionated course of high dose-per-fraction once-weekly radiotherap y. In the majority of cases this consisted of seven exposures of 6.5 G y (five to the involved breast, and two to the tumor bed) given over 6 weeks, on a Co-60 unit. Nodes were treated when clinically involved, to a dose of 27.5-30 Gy in five to six fractions. Results: At median f ollow-up of 36 months, the overall survival rate is 87% [confidence in terval (CI) 78-95%], the disease specific survival rate is 88% (CI 80- 96%), and 72% (CI 60-84%) of patients are free of disease. The local c ontrol rate at 36 months is 86% (CI 76-95%), When analyzed by T stage, 81% of T1 patients, 96% of T2 patients, 60% of T3 patients and, parad oxically 100% of T4 patients were in local control at 36 months, altho ugh at that point there were just four such patients available for con sideration in the T4 group. Initial response to hormone therapy does n ot appear to be a predictive indicator for ultimate loco-regional cont rol. There is a trend towards greater probability of loco-regional fai lure if total dose delivered to the breast is less than 35 Gy. Conclus ions: Women of elderly age are often denied combined modality therapy, because of coexistant disease or fears held by the responsible physic ians that elderly patients are unable to tolerate surgery or protracte d courses of radiotherapy. Consquently, many are treated by tamoxifen alone with poor results. This study demonstrates that very high rates of loco-regional control are achievable using hormonal treatment combi ned with high dose-per-fraction once-weekly radiotherapy.